The definition of ARDS
It is a deadly respiratory disorder, which occurs due to rapid failure of lungs.
The associated clinical indicators
The associated clinical indicators are low blood pressure, increased heartbeat, low arterial oxygen tension, low arterial carbon dioxide tension, high bicarbonate concentration, alkaline condition of pH above 7.4, and low arterial oxygen saturation.
Conditions that the patient experience that are common risk factors associated with ARDS
The conditions experienced by the patient, which are common risk factors associated with ARDS are fatigue in diving, seizures associated with diving, injury to the lungs, near drowning, and inability to swim. Diving is a rigorous activity that causes fatigue, seizures due to swirling, inspiration injury of the lungs by water, and leads to near drowning. At the state of near downing, water entered into the lungs and caused suffocation, and thus, made the patient unable to swim.
Describe the major pathophysiological alterations in ARDS
The major pathophysiological alterations in ARDS are diffuse alveolar damage and inflammation of the alveoli. Entry of water into the lungs due to near drowning damages alveolar membrane and prevents ventilation of blood. The damage of alveoli triggers immune response that leads to the inflammation of lungs and inhibition of ventilation. Eventually, the damage and inflammation of lungs leads to the collapse of alveoli leading to occurrence of ARDS.
What is the common V:Q mismatch associated with ARDS?
Lower V:Q mismatch ratio is commonly associated with ARDS because ventilation is low and perfusion is high.
What is the cause of hypoxemia in ARDS and how is it treated?
The cause of hypoxemia in ARDS is the damage and inflammation of alveoli, which inhibit diffusion of oxygen into the blood. Mechanical ventilation is applicable in treatment of ARDS to promote ventilation mechanism of lungs.
What is the clinical significance of static compliance?
Static compliance has clinical significance because it measures elasticity of lungs. High static compliance implies that the lungs are elastic, while low static compliance implies that lungs are stiff.
How is decreased static compliance demonstrated in the patient’s case?
- Static compliance = Tidal volume / (peak plateau pressure – positive end expiratory pressure).
- Static compliance = 800 / (24-5) = 42.12 ml/cmH2O
The stated initial statistic compliance was 30ml/cm H2O and the calculated static compliance after intubation pressure was 42.12ml/cmH2O, which are lower than the normal level of static compliance (50-100 ml/cmH2O).
Early indications of ARDS include hyperventilation and respiratory alkalosis. What is the interpretation of this patient’s acid-base balance?
The acid-base balance of the patient has been disturbed because arterial carbon dioxide tension (PaCO2) is 26 mmHg, which is below the normal range of 38-52 mmHg
The cause of this imbalance
Hyperventilation removes carbon dioxide from blood and causes the pH of blood to increase above the normal pH of 7.4 leading to respiratory alkalosis.
What effects could PEEP have on the patient’s pulmonary and cardiovascular status?
PEEP could affect pulmonary status by increasing the volume of lungs, distending alveoli, damaging air sacs, and squeezing pulmonary blood vessels. Moreover, PEEP could affect cardiovascular status by decreasing the flow of blood to the heart because of the increased intrathoracic pressure.
The primary nursing diagnosis for this patient upon admission to ICU
As related to the circumstances of near drowning and as evidenced by differential diagnosis, Sanguil and Fargo (2012) assert that the primary nursing diagnosis is arterial blood gas (ABG).
Identification of the top three nursing interventions for this patient. How do these interventions improve pulmonary status?
The top three nursing interventions are mechanical ventilation, fluid management, and pharmacological intervention (Roch, Guervilly, & Papazian, 2011). Mechanical ventilation restores the ability of pulmonary to ventilate blood, while fluid management and pharmacological intervention aim to reduce edema associated with the inflammation of alveoli.
What is the prognosis in patients with ARDS? What increases morbidity?
The prognosis of ARDS indicates that if patients do not receive treatment in time, about 90% of them are likely to die of hypoxemia. However, early treatment increases their survival rate to 70%; however, leaving some patients with cognitive, psychological, and physical abnormalities. The nature of these abnormalities is dependent on risk factors for ARDS that increase morbidity. Since ARDS is a deadly disease, poor or late treatment, severe inflammation of alveoli, positive fluid balance, infections, extensive damage of lungs, and transfusion with packed red blood cells increase morbidity.
References
Roch, A., Guervilly, C., & Papazian, L. (2011). Fluid management in acute lung injury and ARDS. Annals of Intensive Care, 1(16), 1-7.
Sanguil, A., & Fargo, M. (2012). Acute Respiratory Distress Syndrome: Diagnosis and Management. American Family Physician, 85(4), 352-358.